Active NPI
Roseanne Pontillo, MSOM, L.AC.,BS
- Acupuncturist
- Crystal Lake, IL
National Provider Identifier
1760720676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 198.011005
- Practice address
- 3306 Royal Woods Dr
Crystal Lake, IL 60014-4793 - Phone
- (847) 602-2114
- NPI assigned
- Jan 28, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 198.011005 | IL | Primary |
| Acupuncturist | 171100000X | 728-055 | WI |
Addresses
Primary practice location
3306 Royal Woods Dr
Crystal Lake, IL 60014-4793
Mailing address
3306 Royal Woods Dr
Crystal Lake, IL 60014-4793
Phone (847) 602-2114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 198.011005 | IL | MD | Acupuncturist |
| 728-055 | WI | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359331200000",
"number": "1760720676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3306 ROYAL WOODS DR",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600144793",
"telephone_number": "847-602-2114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3306 ROYAL WOODS DR",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600144793",
"telephone_number": "847-602-2114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONTILLO",
"first_name": "ROSEANNE",
"name_prefix": "Ms.",
"credential": "MSOM, L.AC.,BS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-01-28",
"last_updated": "2013-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "IL",
"license": "198.011005",
"primary": true
},
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "WI",
"license": "728-055",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.